final program.qxd - Parallels Plesk Panel

PP 3.25
Frequency, monitoring, clinical significance, treatment, and prevention
determinants of pancreatic toxicity in the era of highly active antiretroviral therapy
(HAART)
Roberto Manfredi, Leonardo Calza
Infectious Diseases, University of Bologna, Italy
Introduction
The epidemiological-clinical features of HIV-associated pancreatic anomalies are evolving
significantly during HAART availability.
Patients and Methods
The frequency, risk factors, and clinical-therapeutic features of pancreatic alterations were
assessed in a case-control study.
Results
Around 1,000 HIV-infected patients (p) were assessed for pancreatic abnormalities during
the whole follow-up period of each p. One hundred and 38 p found with high and/or
prolonged laboratory anomalies were assessed with better detail, in order to outline the
profile of pancreatic disease before and during the HAART era. Compared with control p,
the 345 p (35.6%) who experienced at least one episode of pancreatic laboratory
abnormality had a longer duration of seropositivity, protease inhibitor use, a more frequent
immunodeficiency and AIDS diagnosis, concurrent liver-biliary disease, and
hypertriglyceridemia. Among these 345 p, high and/or prolonged alterations eventually
associated with signs of organ involvement occurred in 133 p, and were associated (with
descending frequency) with the administration of didanosine, stavudine, a PI-based
HAART (and the frequently related hypertriglyceridemia), and lamivudine, or with
substance and/or alcohol abuse, opportunistic infections, liver-biliary disease, and (at a
lower extent), with the use of combined anti-tubercular therapy, pentamidine, or
cotrimoxazole. However, no difference was noticed between the 34 p with clinical and/or
diagnostic imaging (ultrasonographic and/or CT) evidence of pancreatic involvement, and
the remaining 99 asymptomatic p. Although recurrences of enzyme alterations involved
over 70% of p, in only 33.8% of p a change of antiretroviral and/or antimicrobial therapy
proved necessary. An acute but uncomplicated pancreatitis occurred in eight of the 34
symptomatic p (23.5%). A 2-4-week gabexate mesylate and/or octreotide administration
(performed in 48.1% of p), achieved a significant laboratory, clinical, and imaging cure or
improvement in 71.9% of overall treated p, with a better success rate of combined versus
single pharmacologic therapy.
Conclusions
Epidemiological and pathogenetical studies are strongly needed to assess the
significance and the outcome of HIV-associated pancreatic abnormalities in the HAART
era, considering that a broad spectrum of direct and indirect pancreatic toxicity may occur.
Gabexate mesylate and/or octreotide indications strongly deserve controlled studies, also
on a cost-effectiveness point of view. Finally, the frequent persistence of altered serum
pancreatic enzymes is of frequent and relevant concern when re-starting or continuing
antiretroviral therapy in this special p group.
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